The effects of oxygen inhalation at atmospheric pressure (1 ATA.O2) on CBF were studied in subarachnoid hemorrhage (SAH) patients due to ruptured intracranial aneurysms to prove the usefulness of the "O2 response" test for the evaluation of the cerebral vascular response. "O2 response" means the CBF (or ICP) decrease during hyperoxemia. CBF was measured by 10 m Ci 133Xe intravenous injection method using rCBF analyzer BI-1400 (Valmet). Two-compartmental analysis was used for the calculation of initial slope index (ISI). Studied cases were 53 postoperative SAH patients and 100 times examinations were done under the condition of Rest-1 ATA.O2. The incidence of global disturbance of the O2 response was 33% from day 0 to 3, 31% during day 4 to 7, 30% during day 8 to 14, and 23% at day 15 to 30. But, after day 31, there was no case which revealed an impaired O2 response. It was not possible to detect focal or hemispheric abnormalities of the O2 response because of the limitation of noninvasive two-dimensional CBF measurement method employed. The causes of O2 response abnormality, within a month after the onset, were increased ICP, hydrocephalus and diffuse brain damage. Multiple regression analysis proved that elevated PaO2 is the major factor in reducing CBF. CBF and ICP correlation study showed that the higher the Rest ICP, the fewer the CBF decreases during pure O2 inhalation. This may indicate that the increase in ICP in the acute stage changes the O2 response according to the level of increased ICP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1987

[Effects of hyperoxia, glycerol and ventricular drainage on ICP and CBF in patients with increased ICP due to CSF circulatory-absorbance disturbance].

The effects of hyperoxia, glycerol and ventricular drainage on intracranial pressure (ICP) and cerebral blood flow (CBF) were studied in cases with cerebrospinal fluid (CSF) circulatory-absorbance disturbance due to subarachnoid hemorrhage (SAH) or intraventricular hematoma. Ventricular fluid pressure (VFP) was monitored through a controlled ventricular drainage (CVD) tube using a Statham P-50 pressure transducer. CBF was measured by the 10mCi133Xe intravenous injection method using a Valmet BI-1400 rCBF analyzer. ISI (initial slope index) was used for the CBF value. Studied cases were 19 SAH patients and 2 hypertensive intracerebral hematoma cases with intraventricular hematoma. Hyperoxia included hyperbaric oxygen (HBO), reduced ICP and CBF. During pure oxygen inhalation at atmospheric pressure (1ATA . O2), there was a tendency toward a relationship showing that the higher the resting state ICP, the lesser the likelihood of a CBF decrease. This may indicate that increased ICP impairs cerebral vascular reactivity to hyperoxia in relation to the degree of elevation. The effects of hyperoxia on ICP and CBF were temporary and they promptly returned to the resting state after cessation of oxygen inhalation. In some cases, there was a rebound phenomenon in ICP after HBO. Glycerol administration reduced ICP and increased CBF. There was no clear correlation between resting state ICP and CBF increase after glycerol administration. The effects of glycerol were also temporary. ICP control by opening CVD increased CBF. There was a correlation between the level of resting state ICP and the CBF increase after the opening of CVD. In cases with CSF circulatory-absorbance disturbance, elevated ICP reduced CBF and may further worsen the cerebral damage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1987

[Moyamoya disease in twins].

The authors described twins of ten-year-old girls who developed Moyamoya disease at the same time. The family history showed no abnormality. They were born in 1973 under the cesarean section for the early rupture of the membranes and weak pains. The first case experienced tonic convulsions, and abnormal findings on the EEG were pointed out on May, 1979. Seven months later, CT scan was performed in another hospital, which showed the findings of brain atrophy. She experienced absence attacks on January, 1980, and had the first admission. She was diagnosed as epilepsy. Right carotid angiography (CAG) was performed, which showed no abnormal findings. On August, 1983, she complained transient ischemic attacks (TIA) of right hemiweakness and sometimes loss of consciousness for 5 to 10 minutes. She had the second admission on September, 1984. Growing status and neuro-psychological findings were normal. The EEG seemed almost normal, but she complained a TIA on right upper extremity two minutes after the hyperventilation, so the examination was stopped. CT findings was the same as that performed in 1979. Bilateral CAG showed marked stenosis of the internal carotid arteries (ICA) at the siphon and basal moyamoya vessels. Vertebral angiography had no sterno -occlusive lesions. Left encephalo-duro-arterio-synangiosis (EDAS) was performed, and six weeks later, right EDAS. Postoperatively, TIAs disappeared and she had a good clinical course. The second case had a similar history as described in case 1, except the absence of epileptic attacks. EEG abnormality was pointed out, and she also had the diagnosis of epilepsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Arterial Occlusive Diseases↗

PubMed1986

[Normal pressure hydrocephalus after subarachnoid hemorrhage--with regard to pathogenesis and factors influencing the efficacy of shunt surgery].

Twenty-four adult cases of suspected normal pressure hydrocephalus (NPH) after subarachnoid hemorrhage (SAH) were investigated clinically from the aspect of predicting the efficacy of the shunting procedure. They consisted of 13 men and 11 women, with the mean age of 55-y-o. In addition to checking neurological signs, pre- and postoperative CT scans, RI (or CT) cisternography and bolus infusion test were performed in each of them. Shunt surgery was done, all of which ventriculoperitoneal shunt, in 17 patients. They were divided into three groups, namely, shunt effective group (A), neurologically unchanged group after surgery (B) and worsened group (C). The A group had 8 cases, B had 8 also and C contained only one. Effectiveness of shunt procedure was measured by an improvement in the activity of daily life (ADL). Compared with group B, group A tended to have more cases of delayed onset of NPH (mean days of 112 from SAH attack in group A while 55 days in group B), cases with "trias" (3 against 0) and moderate ventricular dilatation with periventricular lucency (8 against 2). The finding of delayed clearance in cisternogram did not make an accurate judgement in the efficacy of shunt surgery. By using the bolus method of infusion test, the true cause of shunt non-effective ventricular dilatation was suggested to the disturbance of cerebral blood circulation due to elevation of intracranial venous outflow resistance. This suggestion was elicited by the analysis of pressure response curve gained from the bolus injection, in which group A cases mainly reached the baseline pressure within 22 minutes, but on the contrary group B showed more than 22 minutes as a rule.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗